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Analysis

Covid-19 Continues Its Toll on Jails and Prisons

The former chief medical officer of NYC Correctional Health Services warns that the situation for people behind bars is deteriorating.

As of May 1, 14,513 incar­cer­ated people and almost 4,000 work­ers in state and federal pris­ons have tested posit­ive for Covid-19, accord­ing to data collec­ted by the Marshall Project. Those figures are likely an under­count of the total number of infec­tions because they only repres­ent people who received a test. More than 200 incar­cer­ated people have died.

In addi­tion to pris­ons, jails are also hard hit by this virus. New York City’s jail system, for example, currently reports that 376 incar­cer­ated people have Covid-19, but they are not releas­ing the cumu­lat­ive number of people who have been infec­ted. As a result, we don’t have a sense of the the total impact of this pandemic on those incar­cer­ated in the city’s jails, a basic data prob­lem that has been seen in other settings as well. Mean­while, at Chica­go’s Cook County Jail, nearly 500 detain­ees and more than 300 correc­tional officers have tested posit­ive.

Many pris­ons across the coun­try currently have far more occu­pants than they were designed to hold, which has led to danger­ously close quar­ters where conta­gious diseases can spread even more rapidly. To discuss the ongo­ing public health crisis, I spoke with Dr. Homer Venters, a phys­i­cian, epidemi­olo­gist, and the former chief medical officer of NYC Correc­tional Health Services, where he played a lead­er­ship role during the H1N1 outbreak in 2009.

I previ­ously caught up with Dr. Venters in March to discuss how Covid-19 could threaten those who live in and work in correc­tional facil­it­ies across the coun­try. At that time, there were no Covid-19 cases repor­ted yet in U.S. jails and pris­ons. We spoke again this week as the numbers of incar­cer­ated people and correc­tional staff who have contrac­ted the virus contin­ues to climb.

This conver­sa­tion has been edited for length and clar­ity.

You have been monit­or­ing condi­tions in correc­tional facil­it­ies over the last few weeks. What are you seeing and hear­ing both from incar­cer­ated people and from correc­tional staff during this crisis?

There is an enorm­ous discon­nect between what’s being repor­ted publicly and what people are actu­ally exper­i­en­cing in jails and pris­ons. None of that should surprise anybody who knows the crim­inal justice system.

The exper­i­ence of correc­tional staff stands out to me. For example, three weeks ago, there was a shift toward provid­ing correc­tional officers across the coun­try with N95 masks. But I’ve talked to many officers, and almost none of them were trained or even told about what the masks are for, when they should be used, and what high-risk situ­ations they are encoun­ter­ing. As a result, there are tens or even hundreds of thou­sands of discarded N95 masks. Other officers have masks but don’t wear them most of the time. Just that one picture shows how we can actu­ally hurt our over­all infec­tion control efforts when we don’t really engage with the staff. I’ve seen this happen before in prior outbreaks. We some­times have a tend­ency to copy and paste infec­tion control ideas and policies from community settings and then plop them down in a correc­tional setting. It does­n’t work and often makes things worse.

Simil­arly, some facil­it­ies will post signs about hand-wash­ing for detained people but then continue to charge them for access to soap. That’s another example of how an infec­tion control idea that was supposed to help slow the spread of Covid-19 behind bars actu­ally made the situ­ation worse, because it exacer­bated the discrep­ancy between what people should do and what they actu­ally can do.

Based on what you’re seeing, if someone in a correc­tional facil­ity starts to feel ill, what are they being told to do? How do they see a doctor? Do they have to pay for that?

On paper, most facil­it­ies, whether a jail or a prison or ICE deten­tion center, would say that they we have more than adequate systems estab­lished. But in my exper­i­ence — based on conver­sa­tions with Covid-19 patients, other patients, and health staff — these systems aren’t work­ing. For example, most facil­it­ies have a broken request-for-care system. People may fill out repeated sick call requests, either via paper or computer, or both, and they may not be seen by a health profes­sional. Or some­body may simply come to their cell and have the most limited amount of patient inter­ac­tion possible without really figur­ing out whether the patient has symp­toms consist­ent with Covid-19. The whole process could take days, and during that time, the patient may get sicker and may trans­mit the virus to people around them.

Covid-19 initially spread very quickly in urban areas but is now also affect­ing more rural areas. What worries you about the grow­ing number of cases in correc­tional facil­it­ies in rural areas?

The spread of Covid-19 in correc­tional systems has had a profound impact on local hospit­als. We have already seen several cases such as in Joliet, Illinois, where a single correc­tional facil­ity can over­whelm the nearby hospital in just a couple of days. Send­ing even a single sick patient to the hospital is disrupt­ive both for jail oper­a­tions and for the hospital, because you’re send­ing one person with two armed correc­tional officers. For most facil­it­ies, if you send in 15 patients a day, you completely deplete your correc­tional staff (who are often work­ing over­time), and you essen­tially take over the hospital — certainly at least the emer­gency room. There are few hospit­als in the coun­try that can handle that many sick patients and the logist­ics involving armed guards.

Rural areas have seen a lot of hospital clos­ings in the last 10 years. Because correc­tional settings like jails, pris­ons, and ICE deten­tion centers are also concen­trated in rural areas, Covid-19 creates the very real prospect that local hospit­als will be quickly over­whelmed as the virus spreads rapidly through­out these facil­it­ies.

If incar­cer­ated people are iden­ti­fied for early release, what happens to ensure that they are not posit­ive for Covid-19 when they leave correc­tional facil­it­ies?

Coordin­at­ing a release can happen the right way in communit­ies where there is already a good rela­tion­ship between the local health depart­ment and the correc­tional facil­ity. Ques­tions to consider include: What’s the safest place for the person to go? Do they need support? Many communit­ies are, for example, reserving and buying or rent­ing hous­ing for people being released.

I want to guard against the notion that incar­cer­a­tion is better for people or for the community, because it’s not. It’s certainly better for every­body if we can promote earlier releases, which will help slow the spread of the virus inside facil­it­ies. But there isn’t really a scen­ario where it’s better to keep people incar­cer­ated because they have Covid-19. As with any other commu­nic­able disease, there are import­ant consid­er­a­tions for how to manage the reentry process. It’s crit­ical for community part­ners like the Depart­ment of Health to get involved in that process, because sher­iffs and correc­tional officers do not currently have skills or resources to manage it.

The pandemic has now been unfold­ing for several weeks in the United States. What concerns you the most about its current traject­ory, espe­cially for incar­cer­ated people?

Nation­ally, there’s an emer­ging narrat­ive that we’re turn­ing the corner on Covid-19. That could be true in certain ways. But this virus is really just now taking hold in correc­tional settings, and I think the worst is in front of us. There’s a great risk that what happens behind bars will be ignored. I also think we’re going to lose a lot of correc­tional staff. I think a lot of staff will get sick — and some have already died — but we may have fewer people work­ing in this space in the fall than we do now. If that happens, the condi­tions could be even worse. I worry that the public will move on and be eager to avoid think­ing about anything related to Covid-19. Addi­tion­ally, incar­cer­ated people are already chron­ic­ally ignored. I’m concerned that things could get much, much worse for them in the upcom­ing months.

I hope that the CDC and that state and local health depart­ments get involved in address­ing Covid-19 in our correc­tions systems. Both now and in the coming months, those entit­ies will have a strong mandate — in large part an economic mandate — to do more coronavirus test­ing and contact tracing so that they can get people back to work, get kids back to school, and restore public confid­ence. All of that is import­ant. But I fear that those same resources will be pulled even further away from efforts to detect and treat life-threat­en­ing illness behind bars. To me, it seems like things will get worse for incar­cer­ated people even if the public narrat­ive starts to go in the oppos­ite direc­tion.